Healthcare Provider Details

I. General information

NPI: 1164400685
Provider Name (Legal Business Name): EXETER COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WATER ST
EXETER NH
03833-2424
US

IV. Provider business mailing address

163 WATER ST
EXETER NH
03833-2424
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-7433
  • Fax: 603-778-0022
Mailing address:
  • Phone: 603-778-7433
  • Fax: 603-778-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number590
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number709
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number38
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number450
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37
License Number StateNH

VIII. Authorized Official

Name: MS. JEANNE ALLEN
Title or Position: PARTNER
Credential: LCSW
Phone: 603-778-7433